| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
6,866 |
6,813 |
$658K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
801 |
788 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,318 |
753 |
$64K |
| D1351 |
Sealant - per tooth |
1,464 |
334 |
$44K |
| D1120 |
Prophylaxis - child |
7,192 |
7,146 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
342 |
223 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
231 |
213 |
$27K |
| D2140 |
|
588 |
411 |
$26K |
| D1206 |
Topical application of fluoride varnish |
7,500 |
7,429 |
$19K |
| D0272 |
Bitewings - two radiographic images |
4,667 |
4,625 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
230 |
228 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,383 |
1,372 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
118 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,411 |
1,357 |
$6K |
| D1110 |
Prophylaxis - adult |
392 |
384 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
43 |
$5K |
| D0330 |
Panoramic radiographic image |
602 |
595 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
721 |
700 |
$2K |
| D2160 |
|
15 |
13 |
$478.12 |
| D0240 |
|
17 |
13 |
$0.00 |